Placement of esophageal self-expanding metallic stents without fluoroscopy

Austin, Andrew; Khan, Zubair; Cole, A.T.; Freeman, Jan G.

doi:10.1067/mge.2001.117153

Cited by 36 publications

(35 citation statements)

References 13 publications

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“…Although, fluoroscopy is the conventional guiding approach for guided stent placement, a procedure without fluoroscopy was introduced by Austin et al [7]. These authors inserted uncovered SEMSs in 30 patients with irresectable esophageal malignancy, achieving deployment in a satisfactory position for 23 of the patients (77%) without any reported major complications.…”

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confidence: 98%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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confidence: 98%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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“…Previous reports of direct endoscopic stent insertion confirm our experience. Austin et al (36) and Wilkes et al (37) reported successful direct endoscopic placement of large caliber uncovered SEMS in 77% and 92% of cases respectively. Unlike Wilkes et al, we always attempted to traverse the stricture following stent deployment.…”

Section: Discussionmentioning

confidence: 99%

Small caliber covered self expanding metal stents in the management of malignant dysphagia.

Kucera

Shridhar

Klapman

et al. 2016

JCO

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Background: Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia. Results: DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases. Conclusions:In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS. The median dysphagia score (DS) improved to 1 in both groups of patients. However, the rigid stent group experienced 14% procedure related mortality, whereas, the SEMS group experienced no procedure related mortality. Similar complication and MRs were observed by others (5-7). Uncovered SEMS rapidly replaced rigid stents for management of malignant dysphagia (8). However, frequent tumor in-growth obstruction problems were encountered (7,(9)(10)(11). Covering the stent mesh reduced tumor in-growth, but increased SEMS migration rates (12)(13)(14). To address both the tumor in-growth problem and the migration problem, manufacturers pursued various design modifications to include covering only a portion of the SEMS body, increasing the SEMS BD, changing the shape of the SEMS body, or a combination of all three.A randomized controlled trial by Siersema et al. (15) of partially covered and covered SEMS designs from three different manufacturers suggested that SEMS with BDs >20 mm were less likely to migrate when placed across distal esophagus and cardia malignant strictures. However, major stent related complications (perforation, bleeding, fever, pressure necrosis, severe pain) occurred in 18% to 36% of patients and overall 30-day mortality was 15%. In the multicenter randomized Dutch SIREC trial (16), 18 and 23 mm BD partially covered SEMS were compared to brachytherapy as palliation for inoperable esophageal adenocarcinoma. SEMS migration occurred in 17% and tumor in-or over-growth occurred in 15% of patients randomized to treatment with the partially covered SEMS. Major stent related complications occurred in 25% of patients. Stent related mortality was 9%.The available data from existing studies suggests that the major complication and MRs for covered or partially covered SEMS with BDs ≥18 mm are similar to those produced by the non-expandable rigid legacy stents that SEMS were designed to replace. Upon...

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“…Recently many authors have demonstrated that endoscopic insertion of esophageal SEMS without fluoroscopy is safe and effective in esophageal malignancy. [10][11][12][13][14][15] Fluoroscopy is required to guide placement of wire across the stricture into stomach, to mark the upper and lower ends of the stricture with radio-opaque markers and for SEMS positioning during deployment. In present study, it was showed that esophageal SEMS insertion under endoscopic guidance without fluoroscopy is simple, safe and effective.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 However few studies have demonstrated that SEMS can be safely inserted under endoscopic guidance alone without fluoroscopy. [10][11][12][13][14][15] This method of SEMS insertion is important in centers where fluoroscopy is not available. …”

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confidence: 99%

Safety of endoscopic self-expanding metallic stent placement in esophageal cancer without fluoroscopy

Jain

Babu

2016

Int Surg J

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INTRODUCTIONThe incidence of esophageal cancer in India is 4.1% (men -5.7%, women -2.7%).1 It is the sixth common cancer in men and eighth common cancer in women in India. 2 Majority of patients with esophageal cancer are diagnosed at a late stage and only palliation is possible.3 . Patients with esophageal cancer have a five year survival rate of 5-10%. 4 Dysphagia is the main symptom of esophageal cancer, causing weight loss and poor quality of life. Palliative treatment of dysphagia with selfexpandable metal stent (SEMS) insertion is an effective and safe procedure.5,6 SEMS insertion is associated with complications like perforation, bleeding, stent migration, tumor ingrowth and stent occlusion. In majority of previous studies, endoscopic SEMS insertion was done under fluoroscopic guidance. 8,9 However few studies have demonstrated that SEMS can be safely inserted under endoscopic guidance alone without fluoroscopy. [10][11][12][13][14][15] This method of SEMS insertion is important in centers where fluoroscopy is not available. ABSTRACTBackground: Esophageal self-expanding metal stent (SEMS) placement is traditionally done under fluoroscopic guidance. But few authors have shown that esophageal SEMS can be placed without fluoroscopy. The study aimed to assess the safety and success of SEMS placement in patients with carcinoma esophagus under endoscopic guidance without fluoroscopy. Methods: All patients who underwent esophageal stenting for palliation of malignant dysphagia over a 4 year period were reviewed retrospectively. Consecutive patients were identified from the endoscopy report books and inpatient admission files of medical gastroenterology department, Victoria hospital. In one hundred and ten patients with inoperable carcinoma esophagus, SEMS was placed. The procedure consisted of proximal release SEMS insertion under endoscopic guidance without the use of fluoroscopy. They were followed at one week and one month after deployment. All the complications related to the procedure were recorded. Results: 110 patients underwent endoscopic esophageal SEMS insertion for palliation of malignant dysphagia. Stent was successfully placed in all the patients. The mean age of patients was 57.38±21.21 years (range: 31 to 84 years). Dilatation of stricture before SEMS placement was needed in 33 patients (30%). No patient had esophageal perforation or stent migration. Conclusions: Esophageal stent insertion in carcinoma esophagus under endoscopic guidance without fluoroscopy is successful, safe and effective for palliation of dysphagia.

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Placement of esophageal self-expanding metallic stents without fluoroscopy

Cited by 36 publications

References 13 publications

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Small caliber covered self expanding metal stents in the management of malignant dysphagia.

Safety of endoscopic self-expanding metallic stent placement in esophageal cancer without fluoroscopy

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